Glossary

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Eligibility Criteria

The criteria used to determine when an insured is eligible to receive benefits under a long term care insurance policy. Typically, these criteria include the following:

• Be certified by a physician as unable to perform two or more ADLs for a period of at least 90 days; or as requiring substantial supervision by another individual to protect him- or herself or others from threats to health or safety due to cognitive impairment;
• Have satisfied the elimination period.
• Have a written plan of care

To maintain eligibility for benefits, most plans require that a physician certification be submitted periodically (e.g., annually).

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